<? include('layer/head.html'); ?>

<body class="ly4 notice">
	<? include('layer/topnav.html'); ?>
	<? include('layer/header.html'); ?>
	<div class="contenter clrfix anchor_reply">
        <div class="box_border">
            <div class="wrap section mpt a_anchor_apply">
                <div class="hd">
                    申请成为签约主播
                </div>
                <form id="anchor_apply_form">
                    <div class="bd">
                        <dl class="fieldset clrfix">
                            <dt> 真实姓名</dt>
                            <dd class="clrfix">
                                <div class="input_wrap fn_left">
                                    <input class="text" name="realname" value="" type="text">
                                    <div class="border_end"></div>
                                </div>
                                <span class="red fn_left">*</span>
                            </dd>
                        </dl>
                        
                        <dl class="fieldset clrfix">
                            <dt> 性别</dt>
                            <dd class="gender clrfix">
                                <div class="select_wrap fn_left">
                                    <select id="selectsex" name="selectsex">
                                        <option value="1">男</option>
                                        <option value="2">女</option>
                                    </select>
                                    <div class="border_end"></div>
                                </div>
                                <span class="red fn_left">*</span>
                            </dd>
                        </dl>
                        
                        <dl class="fieldset clrfix">
                            <dt> 开户银行</dt>
                            <dd class="clrfix">
                                <div class="select_wrap fn_left">
                                    <select id="selectsex" name="selectbank">
                                    	<?php if($banklist){foreach($banklist as $key=>$val){ if($key >= 100){?>
                                        	<option value="<?php echo $key;?>"><?php echo $val['chin'];?></option>
                                        <? }}}?>
                                    </select>
                                    <div class="border_end"></div>
                                </div>
                                <span class="red fn_left">*</span>
                            </dd>
                        </dl>
                        
                        <dl class="fieldset clrfix">
                            <dt> 开户地</dt>
                            <dd class="clrfix">
                                <div class="select_wrap fn_left" style="margin-right:5px;">
                                    <select id="selectprovince" name="province">
                                          <option>10</option>
                                    </select>
                                    <div class="border_end"></div>
                                </div>
                                <div class="select_wrap fn_left">
                                    <select id="selectcity" name="city">
                                           <option>10</option>
                                    </select>
                                    <div class="border_end"></div>
                                </div>
                                <span class="red fn_left">*</span>
                            </dd>
                        </dl>
                        
                        <dl class="fieldset clrfix">
                            <dt> 支行名称</dt>
                            <dd class="clrfix">
                                <div class="input_wrap fn_left">
                                    <input class="text" name="sub_bank" value="" type="text">
                                    <div class="border_end"></div>
                                </div>
                                <span class="red fn_left">*</span>
                            </dd>
                        </dl>
                        
                        <dl class="fieldset clrfix">
                            <dt> 银行卡号</dt>
                            <dd class="clrfix">
                                <div class="input_wrap fn_left">
                                    <input class="text" name="cardnum" value="" type="text">
                                    <div class="border_end"></div>
                                </div>
                                <span class="red fn_left">*</span>
                            </dd>
                        </dl>
                        
                        <dl class="fieldset clrfix">
                            <dt> 开户人姓名</dt>
                            <dd class="clrfix">
                                <div class="input_wrap fn_left">
                                    <input class="text" name="card_user_name" value="" type="text">
                                    <div class="border_end"></div>
                                </div>
                                <span class="red fn_left">*</span>
                            </dd>
                        </dl>
                        
                        <dl class="fieldset clrfix">
                            <dt> 身份证</dt>
                            <dd class="clrfix">
                                <div class="input_wrap fn_left">
                                    <input class="text" name="idcard" value="" type="text">
                                    <div class="border_end"></div>
                                </div>
                                <span class="red fn_left">*</span>
                            </dd>
                        </dl>
                        
                        <dl class="fieldset clrfix">
                            <dt> 联系电话</dt>
                            <dd class="clrfix">
                                <div class="input_wrap fn_left">
                                    <input class="text" name="mobile" value="" type="text">
                                    <div class="border_end"></div>
                                </div>
                                <span class="red fn_left">*</span>
                            </dd>
                        </dl>
                        
                        <dl class="fieldset clrfix">
                            <dt> 常用QQ</dt>
                            <dd class="clrfix">
                                <div class="input_wrap fn_left">
                                    <input class="text" name="qq" value="" type="text">
                                    <div class="border_end"></div>
                                </div>
                                <span class="red fn_left">*</span>
                            </dd>
                        </dl>
                        
                        <dl class="fieldset clrfix">
                            <dt> 地址</dt>
                            <dd class="clrfix">
                                <div class="input_wrap fn_left">
                                    <input class="text" name="address" value="" type="text">
                                    <div class="border_end"></div>
                                </div>
                                <span class="red fn_left">*</span>
                            </dd>
                        </dl>
                        
                        <dl class="fieldset clrfix">
                            <dt> 平时直播时间</dt>
                            <dd class="clrfix">
                                <div class="input_wrap fn_left">
                                    <input class="text" name="worktime" value="" type="text">
                                    <div class="border_end"></div>
                                </div>
                                <span class="red fn_left">*</span>
                            </dd>
							<span class="yellow tishi">填写平时的直播时间，将使签约审核人员更方便的与您取得联系并有助于您更快成为签约主播</span>
                        </dl>
                        
                        <dl class="fieldset clrfix">
                            <dt>&nbsp;</dt>
                            <dd>
                                <label class="checkbox"><input name="agree" type="checkbox" checked> 我已阅读并同意</label><a href="?action=AnchorAgreement" target="_blank" class="yellow">《签约主播用户协议》</a>
                            </dd>
                        </dl>
                    </div>
                    <div class="buttons">
                        <input id="btnsave" class="button_1" type="button" value="提交" >
                    </div>
                </form>
                <div class="service_qq">
                    资料申请提交后请联系签约QQ认证通过&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                    签约QQ：&nbsp;&nbsp;
                    <a target="_blank" href="http://wpa.qq.com/msgrd?v=3&uin=2242093032&site=qq&menu=yes"><img border="0" SRC="http://wpa.qq.com/pa?p=1:504808764:1" alt="点击这里给我发消息"></a>
                    &nbsp;&nbsp;
                    <a target="_blank" href="http://wpa.qq.com/msgrd?v=3&uin=1485046980&site=qq&menu=yes"><img border="0" SRC="http://wpa.qq.com/pa?p=1:41019680:1" alt="点击这里给我发消息"></a>
        		</div>
            </div>
        </div>
    </div>
	<? include('layer/footer.html'); ?>
<? include('layer/foot.html'); ?>
<? include('layer/jsstart.html'); ?>
